Pre-Authorisation Consultant

Startek; Gauteng; On-site; ZAR 300 000 - 400 000; Full time

Job summary

A global BPO services provider is seeking a Pre-Authorisation Nurse in South Africa to provide hospital utilization management and coordinate care. The ideal candidate should be an enrolled nurse with at least 2 years' experience in a private hospital or managed care setting. Strong communication skills and a customer service focus are essential. This position offers exposure to various clinical environments and responsibilities including verifying eligibility and authorizing admissions.

Qualifications

• Minimum of 2 years' experience in a private hospital environment or managed care.
• Must have valid registration with Health Professional Boards.
• Experience with chronic illnesses and disease management.

Responsibilities

• Provide hospital utilization management and coordinate patient care.
• Verify eligibility of cover and authorize admissions.
• Communicate with medical practitioners for health information.

Skills

Verbal and written communications skills

Customer service focus

Problem-solving in a customer-friendly manner

Attention to detail

Critical thinking

Time management

Compassion

Fluent in English

Education

Registration as an Enrolled Nurse, Registered Nurse, or Clinical Associate

Tools

MS Word

MS Excel

MS Outlook

Internet Explorer

Job description

Introduction

Startek is global provider of customer support services, business process outsourcing (BPO), engagement solutions, integrating digital technologies, communication, and data to serve brands worldwide.

Our mission is to combine people, technology and data to deliver customer experience excellence for leading brands. We are currently hiring on behalf of one of our clients within the health administration sector.

Should your profile be a direct match for our vacancy.

Please do apply. Should you be in the market for vacancies within the health administration or managed care space and do not see a vacant role within your specialization, please email and include your specialization in the email subject title.

Duties & Responsibilities

The Pre-Authorisation Nurse provides hospital utilisation management, education / training, and other clinically based activities as assigned, to coordinate care between the medical scheme / managed care organisation, members, providers and the community.

• Verifies eligibility of cover in accordance with medical scheme membership files and medical scheme rules.
• Required to work compress hours shift on a rotational basis.
• Authorises and facilitates admission of the member to a suitable facility subject to the clinical guidelines and protocols of the company.
• Authorises out of hospital visits to specialists.
• Establishes whether the member has any co-morbid conditions.
• Communicates with the admitting facility the details of the admission including the level of care, length of stay and value to the hospital as well as any conditions of the admission.
• Communicates with attending medical practitioner to request specific health information or discounts on specific procedures or equipment.
• Collaborates on a member's care plan in conjunction with other health professionals such as the Medical Advisor, other Case Management nurses within the organisation, dieticians, podiatrists, optometrists, behavioural health specialists, etc, as the case may be.
• Refers patients to Disease Management, where appropriate, during a hospital admission.
• Updates the computer system with the member's clinical and demographic details.
• Prepares, participates in discussions and presents cases at clinical meetings.
• Prepares reports and case summaries as needed.
• Plates special assignments and projects instrumental to the function of the department.
• Performs other duties as needed.

Desired Experience & Qualification

• Qualified as an Enrolled Nurse, Registered Nurse or Clinical Associate.
• Must have a valid registration with applicable Health Professional Boards.
• Minimum of 2 years' experience in a private hospital environment (theatre, casualty, general ward, ICU, etc) or managed care environment.
• Minimum of 1 year experience in a call centre environment within a medical scheme will be an advantage.
• Experience with quality management, medical records reviews, case management within a hospital environment, primary care case management will be an advantage.
• Experience with chronic illnesses and targeted disease states.
• Understanding of the SA healthcare industry and the use of medical scheme / healthcare financing terminology.

Skills and Competencies Required

• Strong verbal and written communications skills.
• Customer service focus.
• Ability to solve problems in a customer friendly manner.
• Attention to detail.
• Critical thinking.
• Time management.
• Compassion.
• Language Requirements: Writing and speaking fluent and corporate English. Speaking and writing other official South African languages would be an advantage.

Registration Requirements

• Current and continued registration with the SA Nursing Council.

Computer Literacy

• Proficiency with the following programs is required: MS Word, MS Excel, MS Outlook/email, MS Explorer/Internet.
• Some prior knowledge/experience with medical scheme administration and/or managed care system.